The heart is a complex structure that acts as a pump to allow blood with its life-giving nutrients to be delivered around the body. The heart is the size of your fist and sits in the middle of the chest pointing towards the left side. It is a muscular structure that beats 100,000 times a day and pumps 5 litres of blood around the body using the blood vessels of the circulatory system. This allows delivery of oxygen and nutrients to all parts of the body and removal of carbon dioxide and waste products.
The heart is contained within a sac called the pericardium and is protected by the sternum and rib cage. The heart is divided into 4 chambers, 2 on the left and two on the right. The right and left sides of the heart are separated by a septum. The smaller upper chambers are called the atria and the larger lower chambers are called the ventricles. There are four valves in the heart which ensure that blood travels in one direction. The mitral valve and aortic valve are on the left side of the heart and the tricuspid valve and pulmonary valve are on the right side of the heart. The contraction of the heart is controlled by your heart’s natural pacemaker called the sinus node which sends electrical signals around the heart to give you each individual heartbeat.
With every heartbeat the heart muscle contracts and pushes blood through both the right and left sides of the heart simultaneously. Blood is pumped from the right side of the heart to the lungs where it picks up oxygen. The blood is returned to the left side of the heart where it is pumped around the body to deliver this oxygenated blood to your vital organs. The deoxygenated blood is returned to the right side of the heart ready to be pumped to the lungs again and continue this cycle. The heart muscle itself has his own constant blood supply in the form of coronary arteries which branch off the aorta as it leaves the heart.
Given the complex nature of the heart structure and function there are a number of conditions that can arise from heart disease. Please click here for more information on these conditions, how they are investigated and how they are managed.
Coronary artery disease
– is a common heart problem and remains a huge public health concern. The coronary arteries supply blood to the heart muscle and with time they can become narrowed due to build-up of fatty material called atheroma. This can compromise the blood supply to the heart and lead to symptoms of angina.
The risk factors for coronary artery disease are smoking, obesity, physical inactivity, age, gender, ethnicity, high blood pressure, high cholesterol, diabetes and family history. To investigate whether you have coronary artery disease involves a clinical history, risk assessment and physical examination. Important tests include blood tests, 12-lead ECG, echocardiography and CT coronary angiography.
Treatment options include lifestyle changes including diet and exercise advice, smoking cessation and weight loss if needed. There are a number of medications that minimise risk, slow the progression of coronary artery disease and alleviate symptoms. Some patients with coronary artery disease may benefit from percutaneous coronary intervention (PCI). This is an invasive procedure performed after coronary angiography using wires, balloons and stents (drug coated metal scaffolds) to treat the atheroma and improve blood flow to the heart muscle (see ‘Treatment’ section for more information). Dr Chandra will create a tailored management plan for you depending on your individual needs.
Treatment options include lifestyle changes including diet and exercise advice, smoking cessation and weight loss if needed. There are a number of medications that minimise risk, slow the progression of coronary artery disease and alleviate symptoms. Some patients with coronary artery disease may benefit from percutaneous coronary intervention (PCI). This is an invasive procedure performed after coronary angiography using wires, balloons and stents (drug coated metal scaffolds) to treat the atheroma and improve blood flow to the heart muscle (see ‘Treatment’ section for more information). Dr Chandra will create a tailored management plan for you depending on your individual needs.
Heart rhythm disorders
– affect the electrical co-ordination of the heartbeat and are referred to as arrhythmia. Each heartbeat is controlled by the electrical conduction system of the heart and arrhythmia occurs when there are problems that make the heartbeat too fast, too slow or irregular. There are many types of arrhythmia including atrial fibrillation, atrial flutter, supraventricular tachycardia (SVT), heart block and tachy-brady syndrome.
The symptoms of arrhythmia vary but can include palpitations, dizziness, blackouts, breathlessness, chest discomfort and fatigue. In some cases there are no symptoms at all. The commonest causes of arrhythmia are coronary artery disease, heart attack, heart failure or heart muscle disease (cardiomyopathy). There are also rare inherited conditions that cause arrhythmia including long QT syndrome and Brugada syndrome.
Arrhythmia can be diagnosed with a 12-lead ECG at the time of symptoms though prolonged heart rhythm monitoring is often required (24-hr Holter, 7-day Event recorder). Evaluation of the heart from a structural perspective with either an echocardiogram or cardiac MRI scan is also important. Further tests depends on the cause and range from blood tests to invasive electrophysiological studies of the heart.
Arrhythmia can be diagnosed with a 12-lead ECG at the time of symptoms though prolonged heart rhythm monitoring is often required (24-hr Holter, 7-day Event recorder). Evaluation of the heart from a structural perspective with either an echocardiogram or cardiac MRI scan is also important. Further tests depends on the cause and range from blood tests to invasive electrophysiological studies of the heart.
Treatment for arrhythmia ultimately depends on the underlying cause. The most common treatment include lifestyle advice and medications. In some cases normal heart rhythm can be restored with cardioversion or catheter ablation. Some individuals will benefit from cardiac device therapy (permanent pacemaker implantation, implantable cardioverter defibrillator or cardiac resynchronisation therapy). Please read the ‘Treatment’ section for more information. Dr Chandra will go through these options with you in detail with the aim of ensuring you can live a normal active lifestyle.
Heart valve disease
– the heart has four valves that ensure blood flows in the right direction. Any of these valves can become diseased or damaged and affect the flow of blood leading to symptoms. If a heart valve does not open fully, termed valvular stenosis, it can restrict the flow of blood and cause strain on the heart. If a heart valve does not close fully, termed valvular regurgitation, it can cause blood to leak backwards in the wrong direction and this can also put strain on the heart. The commonest heart valve disease in adults are aortic stenosis and mitral regurgitation.
The commonest cause of valve disease is age-related degeneration. Some people are born with valve abnormalities which manifest with symptoms in later life (congenital heart disease). Rheumatic fever in childhood can also cause valve damage which manifests with symptoms in later life (rheumatic heart disease). Heart valve disease can occur after a heart attack, with infection (endocarditis) or associated with heart failure or heart muscle disease.
The commonest cause of valve disease is age-related degeneration. Some people are born with valve abnormalities which manifest with symptoms in later life (congenital heart disease). Rheumatic fever in childhood can also cause valve damage which manifests with symptoms in later life (rheumatic heart disease). Heart valve disease can occur after a heart attack, with infection (endocarditis) or associated with heart failure or heart muscle disease.
Heart valve disease can cause symptoms of breathlessness and fatigue. In severe cases there may also be dizziness or blackouts particularly if the aortic valve is affected. Some people do not experience symptoms at all. Valve disease can be diagnosed when your doctor hears a heart murmur with their stethoscope. An echocardiogram will be able to evaluate your heart valves in more detail.
If heart valve disease is severe further tests will be required and you may ultimately need valve intervention in the form of ‘keyhole’ procedures or open-heart surgery. If you are diagnosed with heart valve disease that is not severe you may require treatment with medications and require surveillance with echocardiography on an annual basis. Dr Chandra has a specialist interest in heart valve disease and performs transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. He works closely with a network of Cardiothoracic surgeons as colleagues if heart surgery is needed.
If heart valve disease is severe further tests will be required and you may ultimately need valve intervention in the form of ‘keyhole’ procedures or open-heart surgery. If you are diagnosed with heart valve disease that is not severe you may require treatment with medications and require surveillance with echocardiography on an annual basis. Dr Chandra has a specialist interest in heart valve disease and performs transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. He works closely with a network of Cardiothoracic surgeons as colleagues if heart surgery is needed.
Heart failure
– is a common diagnosis and remains a massive public health challenge. Heart ‘failure’ sounds dramatic but is a broad term that simply means the heart is unable to pump blood around the body efficiently. This can affect how well the heart can contract (systolic heart failure) or how well it can relax (diastolic heart failure) or both.
The commonest cause of heart failure is coronary artery disease and/or heart attack causing long standing damage to the heart. It can also be caused by heart valve disease, heart rhythm abnormalities, congenital heart disease, heart muscle disease (cardiomyopathy) and high blood pressure. Heart failure can also be caused by infection/inflammation of the heart muscle, heart valves or the heart lining, as well as low blood counts (anaemia), excess alcohol intake, obesity and hormone imbalances.
The main symptoms of heart failure are shortness of breath (at rest or on exertion), fatigue and swelling of the feet and ankles. Heart failure can be suspected after clinical history, physical examination and risk factor evaluation. Diagnosis also relies upon blood tests, 12-lead ECG, chest X-ray and echocardiography. Appropriate treatment of heart failure depends on the underlying cause and there are a number of medications that can help alleviate symptoms and improve prognosis. Depending on the cause of your heart failure, there are invasive strategies that may also help including percutaneous coronary intervention (PCI), cardiac device therapy, intervention for structural heart disease or electrophysiological studies & ablation.
There is much that you can do for yourself to improve heart failure involving lifestyle changes. This includes monitoring for signs of weight gain suggesting excess fluid build-up, monitoring salt & fluid intake, and participating in regular exercise. A healthy balanced diet is important and will help manage heart failure and your overall health in general. Even with a diagnosis of heart failure, Dr Chandra will aim for you to have an active lifestyle with a fulfilling quality of life.
The commonest cause of heart failure is coronary artery disease and/or heart attack causing long standing damage to the heart. It can also be caused by heart valve disease, heart rhythm abnormalities, congenital heart disease, heart muscle disease (cardiomyopathy) and high blood pressure. Heart failure can also be caused by infection/inflammation of the heart muscle, heart valves or the heart lining, as well as low blood counts (anaemia), excess alcohol intake, obesity and hormone imbalances.
The main symptoms of heart failure are shortness of breath (at rest or on exertion), fatigue and swelling of the feet and ankles. Heart failure can be suspected after clinical history, physical examination and risk factor evaluation. Diagnosis also relies upon blood tests, 12-lead ECG, chest X-ray and echocardiography. Appropriate treatment of heart failure depends on the underlying cause and there are a number of medications that can help alleviate symptoms and improve prognosis. Depending on the cause of your heart failure, there are invasive strategies that may also help including percutaneous coronary intervention (PCI), cardiac device therapy, intervention for structural heart disease or electrophysiological studies & ablation.
There is much that you can do for yourself to improve heart failure involving lifestyle changes. This includes monitoring for signs of weight gain suggesting excess fluid build-up, monitoring salt & fluid intake, and participating in regular exercise. A healthy balanced diet is important and will help manage heart failure and your overall health in general. Even with a diagnosis of heart failure, Dr Chandra will aim for you to have an active lifestyle with a fulfilling quality of life.
Inherited Cardiac Conditions
– are rare, genetic disorders of the heart that can be passed on through families. If undiagnosed or left untreated, these conditions can be life-threatening. Many people with inherited cardiac conditions have no symptoms whatsoever. However, some can develop palpitations, dizziness, blackouts or shortness of breath. Sadly, the first sign of an inherited cardiac condition can be when someone dies suddenly with no clear cause. This is termed sudden cardiac death (SCD) or sudden arrhythmic death syndrome (SADS).
The commonest forms of inherited cardiac conditions are heart muscle disease (cardiomyopathy) and ion channelopathy. Examples of cardiomyopathy include dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Examples of ion channelopathy include Brugada syndrome (BrS), long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT).
The commonest forms of inherited cardiac conditions are heart muscle disease (cardiomyopathy) and ion channelopathy. Examples of cardiomyopathy include dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Examples of ion channelopathy include Brugada syndrome (BrS), long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT).
Inherited cardiac conditions can be challenging to diagnose but should be considered if a family member (1st degree relative) has already been diagnosed or if there is a family history of cardiac arrest or premature death (under the age of 40). After detailed clinical evaluation and family history you will require a 12-lead ECG and echocardiogram in the first instance. It may be necessary for onward referral to a dedicated inherited cardiac conditions clinic for further evaluation and consideration of genetic testing. Treatment for an inherited cardiac condition can vary from changes to your lifestyle, medications to cardiac device therapy with implantable cardioverter defibrillators (ICDs) depending on your risk. Dr Chandra completed a clinical research fellowship with ‘Cardiac Risk in the Young’ and has a wealth of experience managing individuals with inherited cardiac conditions.
Sports Cardiology
– is a growing field of Cardiology and Dr Chandra has a specialist interest in this area. He previously worked in the dedicated Sport Cardiology clinic at St Georges University of London and completed his MD (Res) as a clinical research fellow. This involved regularly evaluating elite athletes as part of pre-participation screening for their governing bodies including the International Olympic Committee (IOC), the Federation Internationale de Football Association (FIFA), the Union of European Football Associations (UEFA), the English Premier League (EPL), Lawn Tennis Association (LTA), the International Cricket Council (ICC) & English Cricket Board (ECB).
Athletes remain a unique subset of individuals who are at the peak of physical fitness. If you are an elite athlete, professional athlete or an athlete in training you may require pre-participation screening. There are also certain (rare) heart conditions that can affect athletes and have important implications. If you are an athlete and have any concerns about your heart health please do not hesitate to get in touch for a specialist consultation.
Athletes remain a unique subset of individuals who are at the peak of physical fitness. If you are an elite athlete, professional athlete or an athlete in training you may require pre-participation screening. There are also certain (rare) heart conditions that can affect athletes and have important implications. If you are an athlete and have any concerns about your heart health please do not hesitate to get in touch for a specialist consultation.
